A Case of Paradoxical Renal Embolism through Patent Foramen Ovale

Korean Journal of Nephrology 2011;30(6):667-670.

Dae Seop Lim, M.D., Eun Soo Jeong, M.D., Jin Sung Jung, M.D., Se Heon Chang, M.D., Seung Hyen Yoo, M.D., Woo Jin Jang, M.D. and Shi Jung Chung, M.D.

Department of Internal Medicine, Hanil General Hospital, Seoul, Korea

증례 : 난원공개존을 통한 기이성 신 색전증 1예

임대섭, 정은수, 정진성, 장세헌, 유승현, 장우진, 정시정

한일병원 내과

Abstract

Paradoxical embolism is a kind of stroke caused by embolism of thrombus of venous origin through a lateral opening in the heart, such as a patent foramen ovale (PFO). Although the most frequent manifestation of paradoxical embolism is cryptogenic stroke, noncerebral paradoxical embolism is also associated with PFO. We experienced a case of cryptogenic renal infarction in a previously healthy 70-year-old man. He had no cardiac thrombus on transthoracic echocardiography and electrocardiogram revealed a normal sinus rhythm. Because it was cryptogenic renal infarction, we performed transesophageal echocardiography with microbubble test. Microbubble test using agitated saline proved the presence of right-to-left shunt and patent foramen ovale was diagnosed. We also performed lower leg doppler ultrasonogram, but there was no evidence of deep vein thrombosis. Although only the presence of a right-to-left shunt is not enough to establish the diagnosis of paradoxical embolism, it is uncommon for the source of the embolism to be identified. In this case, we concluded that paradoxical embolism is the cause of renal embolism. We report paradoxical renal embolism through PFO with review of relevant literatures.

Key Words: Paradoxical embolism, Kidney, Infarction, Patent foramen ovale (PFO)